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XPLICATiON FOR ASION-P�FOR OFFICE USE: SAN{TPermit Na.PAP!, Pete i�Tiplt / ?. ----------- _ Date Issue -- --=-•---- ----------------------- This Permit Expires t Year From Date Issued ------ --------------------------------- -- ------- ---- -----"--"-= - ------------ i ermit to construct and install the work herein Ort for p Rules and Regulations: Apphereby Ordinance No. 549 and ex! sfiing Application 'is applicat one is madeincompliance witlh Countyealth tr+c ® I=NSUS TRACT -1--- ....... described. T PP _je* �� �-- --- JOB ADDRESS/LOCATION ---- --- --- _ ----- -- -------- --Phone ----- ------- -----------------• - -------------- ----- - Owner's Name ��~r'`�"u" - City - -- Phone ------------------------------ Address -------------------------- ` Address --- --- ------.License # ------- - ---- -- I # --------------- -------------------- - Contractor's Name -- '�'`� i Commercial :oTrailer Court l❑ Residence A Apartment House❑ installation will serve: 3� Motel ❑Other -------------------------------------------- -- -- Garbage Grinder .--_------- Lot Size ------ -------------------- - units:.--"�------ Number of bedrooms 2------- --------------------Private Number of living ---- t _ - Water Supply: Public System and name ------------------ Sandy LoamA Clay Loam :❑ Peat❑ ----�- �- ..r Silt❑ Clay ❑ --� �� Character of soil to a depth of 3 feet: Sand'❑ Fill Material ..---------- if yes, type -"---- ` - ��Hardpan ❑ Adobe ❑ fn f� buildings, etc. must be placed on reverse s;de.1 `1 � v (plot plan, showing size of lot, location ofstern +t permitted if public sewer is available within 200 feet,) `, tic tank orseepage P th .--I/-- ---------------- F . NEW INSTALLATION: (No sapO "�' _�.�---- ------- ---- Liquid Dep SEPTIC TANKS Sizej_/-" - -- _ No. Compartments --------------•--•---- PACKAGE TREATMENT [ ] ,�j�. Material__ r " " �" t�-------- TYPel Capacity v Line -.-- ` ------ ---Foundation _10-1 Prop. i (� ------ Distance �to nearest: Well _--_ Total Len th -- ---- ------ I ------------------- Length of each line----C� --- ---------- ? LEACHING LINE '] No. of Lines �,,�,► Depth Filter Material 'D' Box �- Type Filter Material ------- Property Line -`�-------•No---'- S Foundation J-4-1- - - --------- Distance to nearest: Well ---------- ----------�-- --- _-__ -- Rock Filled Yes [] ' Depth _ Diameter ------------- --- Number -- ----------- - SEEPAGE PIT L 1 ---------- ------ -------- Water Size -----------------------•- Water Table Depth ----------------------------- ---------- - _. Prop. Line -------- -------------- ell --------------- + Distance to nearest: Well - ----------------1 ----�--- - -- ------ Date -------•---------- I -------------------------- REPAIR/ADDITION(Prev. Sanitation Permit _-"----- ---------"-_-_--_--_-_- k �T- .............. -_ Septic Tank (Specify Requirements} ---------------------------- Disposal Field (Specify Requ+remen ------------------ --------------------------------------------------------------------------------------- - _ - - -------------- ------"------- (Draw existing and required addition on reverse side) ill be done in ce h Son I hereby certify that I have prepared this application and that the worokawuin LocaI Health DistrictnHome'towner or lcenn County ordinances, State taws, and Rules and Regulations of the. San 9 person in such manner 5ed agents signature certifies the following: permitfor which is issued, I shall not employ any "I certify that in the performance of the worion laws of+ California." as to become subject to Workm�_ ev ---------- Owner Signed ----------------- _ _ ----------- ------ Title ---- ---- --- ---- ---------- - BY --- ---"----------------- (if other than owner) ,FOR D PARTMENT USE ONLY ---- ---------------------- ---- DATE ..-----r=-- i DATE -------- ------------------ ----------- APPLICATION ACCEPTED -BY ' --- ---- -- ---- --,-.� -7L- BUILDING PERMIT ISSUED --------------------------------------------- ------ ------- - 9- ADDITIONAL COMMENTS } - ---4------- ----------------------- ADDITIONAL - -- -- -•----- ------------------------ ----- ------ _ ---------------------------------------------- ----- ------------ ---------- Date - V--- --- Final Inspection by: - -- -------------------- F SAN JOAQUIN LOCAL HEALTH DISTRICT e r ,, n 1-'AA RRv. 5M -